How congress delegates will be able to weigh the evidence

The importance of both quantitative and qualitative research evidence to physical therapists will be examined at next year’s International WCPT Congress. Simon Crompton talks to some of the main contributors on evidence based practice.

A new international collaboration to produce evidence based recommendations for daily physical therapy practice will be announced at next year’s WCPT congress, as part of a range of sessions and activities based around evidence based practice. 

Philip van der Wees from the Netherlands, along with Chris Maher from Australia, Christopher Powers from the United States, Aimee Stewart from South Africa and Ann Moore from the UK will all take part in a focused symposium where they will discuss a new international network of researchers, clinical guideline developers and practitioners that will collaborate in producing evidence-based recommendations.

“At an international level, we believe it is important to produce evidence based recommendations, as well as guidelines,” says Philip van der Wees, a physical therapist and human movement scientist from Amsterdam, who has just been appointed Chair of the Guidelines International Network (G-I-N) – the international not-for-profit association of organisations and individuals involved in the development and use of clinical practice guidelines. He was appointed to its board last October, the first non-medic to be made a board member.

“We think it’s important to address the issue of how you apply evidence to local situations. With short recommendations, of two to three pages, we can say there is good evidence in these areas, and then leave it to individual countries to develop full guidelines from these recommendations so that they are adapted to local situations.”

The evidence-based recommendations will be derived from current high quality clinical guidelines and systematic reviews. They should help physical therapists make decisions in diagnosis and treatment.

According to van der Wees, there is still resistance to the idea of evidence based practice (EBP), partly because of misunderstandings about what it means. “People think it means that you should only do something if there is 100% evidence behind it,” he says, “but it’s actually a combination of evidence from the literature combined with clinical expertise and evidence from the patient. There’s lots of room for individual decision-making and patient feedback.” In the Guidelines International Network, he said, there is increasing awareness that evidence based guidelines needed to take account of daily function, and not just medical diagnosis and treatment.

Chris Carpenter from the United Kingdom also wants to emphasise that EBP isn’t always what physical therapists expect, in the focused symposium she is chairing entitled “Qualitative Research Evidence: how does it contribute to evidence based practice?”

“I don’t think EBP has been as embedded in the practice of many countries as it should have been,” says Chris Carpenter, who is a Reader in Physiotherapy at Coventry University. “Many of the barriers have stemmed from a very narrow definition of EBP, and as physical therapists I think we’ve hung too much on to the medical based model without questioning whether it is appropriate to our practice.”

Physical therapists have to think beyond randomised controlled trials, and towards the use of extended case and qualitative studies. “In the focused symposium I’m hoping to introduce people to what qualitative research is, and what it isn’t and its contribution to EBP,” she says. 

Another speaker at the symposium will be Patty Solomon from Canada. “My message would be that qualitative research has become increasingly relevant as PTs have become more aware of the need for patient centered practice,” she says. “Through a greater understanding of the lived experiences of those with whom we interact, we are able to adapt our assessment and management strategies to best meet their needs.”

Delegates to the congress will be able to follow other discussions and sessions on EBP. In the focused symposia, there will be discussions on:

  • web-based resources to support evidence based physiotherapy
  • Cochrane systematic reviews – enabling evidence based physiotherapy after stroke
  • development of evidence based recommendations for physical therapy diagnosis and treatment.

There will also be education sessions on:

  • physical therapy in Parkinson’s disease: towards evidence based practice
  • evidence based evaluation and treatment for back and knee pain in older persons 
  • evidence based physiotherapy and assessment of quality of the systematic reviews and clinical trials.

A discussion panel on research in the 21st century, led by Ann Moore, Chair of the congress International Scientific Committee, is another session that will engage delegates in debate. And journal editors and a range of researchers will be available to talk to delegates about getting going in research and writing for publication.